Provider Demographics
NPI:1538167531
Name:SANDENO, WILLIAM SCOTT (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:SCOTT
Last Name:SANDENO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1115 SE 164TH AVE
Mailing Address - Street 2:DEPT 358
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-9324
Mailing Address - Country:US
Mailing Address - Phone:360-738-2200
Mailing Address - Fax:360-752-8683
Practice Address - Street 1:4545 CORDATA PKWY
Practice Address - Street 2:SUITE 2B
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-7263
Practice Address - Country:US
Practice Address - Phone:360-738-2200
Practice Address - Fax:360-752-5683
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00037177207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1538167531Medicaid
WA42011OtherREGENCE
WA8240277Medicaid
WA0230384OtherL&I AND CRIME VICTIMS
WA5751735OtherAETNA
WAG8872902Medicare PIN
WA42011OtherREGENCE